We carried out this announced inspection on 18 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Dental Practice is in Addiscombe, Croydon and provides NHS and private treatment to patients of all ages.

There is level access via a portable ramp, for people who use wheelchairs and those with pushchairs. Car parking spaces are available for patients in surrounding roads.

The dental team includes four dentists, three dental nurses, one trainee dental nurse, and one dental hygienist. One of the nurses also covers reception duties. The practice is set out over two levels. The ground floor has one treatment room, and there are three treatment rooms on the first floor as well as the patient waiting room. The practice also has a dedicated decontamination room and an X-ray room.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Dental Practice was one of the principal dentists.

On the day of inspection we collected five CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses (this included one nurse who was covering reception duties). We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: 8.30am to 5.30pm Monday to Fridays. The practice closes from 1.00pm to 2.00pm for lunch. They also offer extended hours on a Thursday and close at 6.30pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

There were areas where the provider could make improvements. They should:

Review the practice’s protocols for referral of patients and ensure urgent referrals are  monitored suitably. 

We carried out an announced comprehensive inspection of this service on 30 April 2015 as part of our regulatory functions, where a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We followed up on our inspection of 30 April 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We have not revisited Leong & Motlagh Dental Practice as part of this review because The Dental Practice was able to demonstrate that they were meeting the standards without the need for a visit.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leong & Motlagh Dental Practice on our website at www.cqc.org.uk.

Leong and Motlagh Dental Practice is a general dental practice in Addiscombe, Croydon offering both NHS and private dental treatment. The practice treats adults and children.

The premises consists of a waiting area on the ground and first floors, a reception area and four treatment rooms. There is also a separate decontamination room.

The staff structure of the practice consists of the joint providers (the two principal dentists), an associate dentist, two part time receptionists and four dental nurses. The practice has the services of three part time dental hygienists who carry out preventative advice and treatment on prescription from the dentist.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We spoke with one patient on the day of our inspection and reviewed seven comment cards that had been completed by patients. Common themes were patients felt they received excellent care from caring and friendly staff who treated them with respect.

We found that this practice was providing safe, effective, caring and responsive care in accordance with the relevant regulations. However we found that this practice was not providing well-led care in accordance with the relevant regulations.

Our key findings were:

• There were effective systems in place to reduce the risk and spread of infection. We found all treatment rooms and equipment appeared very clean.

• There were systems in place to check all equipment had been serviced regularly, including the suction compressor, autoclave, fire extinguishers and the X-ray equipment.

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• Patients told us through comment cards they were treated with kindness and respect by friendly and caring staff.

• Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.

• The practice did not have effective systems in place to assess, monitor and improve the quality and safety of the services provided.

• The practice did not have effective systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• The practice did not have effective systems in place to regularly seek and act on feedback from patients and staff for the purposes of continually evaluating and improving the service provided.

We identified regulations that were not being met and the provider must:

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Seek and act on feedback from patients and staff for the purposes of continually evaluating and improving services.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Implement a documented process for identifying, investigating and learning from incidents relating to the safety of patients and staff members.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
• Ensure findings from audits and risk management processes are discussed with the whole practice team, to ensure learning is shared.
• Consider formal training for the practice team to ensure they are familiar with the Mental Capacity Act 2005 and its relevance to dental practice.
• Establish systems to regularly assess, monitor and improve the quality of service provided (other than in the areas of infection prevention and control and quality of X-ray images).

• Ensure accurate and contemporaneous clinical patient records are always maintained.